Involvement of the Brain Stem in the Presence of Subdural Hematoma

One of the most striking characteristics of subdural hematoma is its capacity for producing complex and variable symptomatology. From the time of its emergence as a disease entity out of the group of pachymeningitis hemorrhagica interna, the effective therapy for this condition has remained essentially unchanged and the problem has been posed as one of diagnosis. Accordingly, the study of subdural hematoma has been concerned largely with the clinical appearance of the disease as a syndrome requiring early and forthright recognition for its successful treatment. Even from the earliest reports, the impression is gained of the diverse and shifting character of the presenting picture. In the clinical study of Trotter¹in 1914 the main characteristics of the condition were already described: trauma, often slight, was considered the invariable cause; a latent interval of hours to days was noted, followed by the prodromal symptoms of headache and generalized retardation. The